END OF SESSION POINTERS Grounding for the Client and the Counselor This is not meant to insult the reader whose experience could easily be far more than mine, but I have often been asked how I end sessions, and particularly with DID clients. I have been shocked and distressed on hearing from more than one Multiple that when feeling highly suicidal, they have been turned out of the office by their reputedly very experienced Therapists with no resource for help given or plan addressed; that they have not been grounded following a severe abreaction, or that switching has left an aggressive, hostile part 'out' (meaning the one in control of the body), who is determined do harm to someone or something on leaving!! Thus, whether a neophyte graduate beginning their counseling career or one having many years tucked under their belt, it behooves us all, and I speak especially to myself, to be reminded of the welfare of the client in all areas, end of session being not the least important. These are a few Pointers only. There are so many one can come up with. The 3 'S's: Safety, Sanity, and Security , are my own personal guidelines for allowing a DID patient to leave a session. They need not be for others if they have their own. There are many ways to ground a person, using various methods such as visualization, meditation, relaxation tapes or music,etc, but overall, if the person feels safe, that they are not going crazy, and there is a good support system or person, (including the therapist), available, they will not feel they are left adrift to float with whatever fears, doubts or emotions they are experiencing as they go out through the door. a) The first consideration is always one of SAFETY. In what condition is the client at the end of session ? Suicidal, in tears, rageful, mute etc? I try to address where they are at and what can help them feel safe and grounded enough to go home. If they need to wait a while to get a hold of themselves, ALLOW this. For DID clients (or any client in crisis or severe distress), rigidly insisting they leave on the dot of the fifty minute "hour," is abusive and unnecessary. I am often uncomfortable on hearing from men and women how their therapist refuses to go one second over the stipulated time. It is inconsciable to cut a child alter off ( or anyone), in mid sentence or if they are crying, knowing this will create chaos through the whole system, and is, to me, an example of poor therapy. It is a given intervention that if the client is suicidal the basic procedures are addressed for the present and immediate future. Again, it is helpful for the client to have a therapist who will DISCUSS their suicidal thoughts and feelings and not avoid or ignore them. b) If the time is nearing for end of session and a distressed state is obvious, start closure early to give plenty of time for grounding. c) For DID clients, where parts/alters may have come out for time, with or without the host using time, it will depend on the age, role and mood of the insiders as to how to end the session. Most importantly, they need to be acknowledged for where they are at that time in terms of what they are feeling and how they perceive the world as they leave. If they leave feeling they have been heard and that their input is respected no matter whether it is friendly or hostile, they will be more apt to leave feeling they can cope. This is the basis for the client experiencing a sense of SECURITY on leaving. d) For host and insiders, where material has been difficult, and especially if there has been an abreaction, assurance of where they are in the here and now will help to ground them. If there is a support person available to be with them on leaving or on arrival at home this can be requested to help the safety issue and give some sense of stability/security. It is dangerous to allow a client to leave who has not been FULLY brought out of a past memory and believes they are still living in it. This also addresses SAFETY and SECURITY. It is crazy-making for a client to feel their past is their present when leaving a session - and careful orientation from that -was -then, to this- is-now, needs to be firmly but gently brought about until it is genuinely and thoroughly understood. This is the basis for the client to feel they have retained their SANITY on leaving. e) Reality test - make sure the client is oriented (time,place,person) and if a child alter is out, ask for the host or an adult alter to come out and take over. Grounding means having ones two feet on solid ground. This cannot be literally or figuratively, if it is a child (who loves to think they can drive), who leaves the office and their feet don't touch the accelerator in the car ! Believe me, I've had this nightmare to cope with! SAFETY needed. f) It is vital for the counselor to have a good support system - and to not overextend in having and treating numbers of DID patients in their case load. It is impossible in such a case to give what is needed either to their clients or themselves in this extremely taxing work over a long period of time. It could easily result in the therapist spending time and energy with one or two clients that could deprive others of the therapist's best efforts from exhaustion. The danger and vulnerability of crossing the therapist/client boundary to therapist/friend role, or worse, friend/friend dual relationship is considerably higher in my mind, where DID is present, for many reasons. This alert addresses private practive and not inpatient clinics where there is a reasonable patient/staff ratio and numbers are not an issue. Also, patient interaction is not confined to one person exclusively. Allowing a break between sessions and not scheduling back to back allows for time to ground oneself. After a very difficult session I find it helpful to relax in what ever way one finds best and later take to supervision what is needed for advice and help. Doing something completely apart from wearing a therapist's hat is always good, whether it be a short physical exercise, mental excercise (could be a game), phone call to a friend, or munch a goodie. Whatever it takes to get grounded. We all have our own ways of self-soothing and distraction. If we don't, we need to think of some! When we take care of ourselves we are better able to take care of our clients and maybe these pointers can be a little help with this ? Goessoftly Retired Therapist www.goessoftlyishere.com (permission for reprints is required)   | Normalizing and Demystifying DID | DID and Littles.(Child/Young Alters) | ISOLATION | Mono's Disbelief | Distortion: Good and Evil | ASPECTS OF BODY CHANGES | Relationships | Across The Board | Across The Board | FORGIVENESS | I am BAD | Headaches | LYING AND DECEPTION | LOST and LOSS | EYES | Controversy. 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